Unplanned 30-Day Readmission in Glioblastoma Patients: Implications for the Extent of Resection and Adjuvant Therapy
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Patient Selection and Treatment
2.2. Clinical, Pathological, and Radiological Assessment
2.3. Statistical Analysis
3. Results
3.1. Baseline Data
3.2. Unplanned Early Readmission
3.3. Overall Survival
3.4. Readmission, Extent of Resection, and Adjuvant Therapy
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
EOR | extent of resection |
ICU | intensive care unit |
KPS | Karnofsky Performance Scale |
LOS | length of stay |
MGMT | O6-methylguanine DNA methyltransferase |
MRC-NPS | medical research council neurological performance scale |
RCx | radio-chemotherapy |
ROC | receiver operator characteristic |
Rx | radiotherapy |
SSI | surgical site infection |
UER | unplanned early readmission |
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All | without UER | with UER | p Value | ||
---|---|---|---|---|---|
n | 276 | 239 | 37 | N/A | |
Sex | male | 175 (63.4) | 150 (62.8) | 25 (67.6) | 0.573 |
female | 101 (36.6) | 89 (37.2) | 12 (32.4) | ||
Age, years | 68.4, 32.6–86.7 | 69.9, 32.6–86.7 | 66.5, 33.8–84.4 | 0.065 | |
Hemisphere | right | 123 (44.6) | 111 (46.4) | 12 (32.4) | 0.033 * |
left | 113 (40.9) | 98 (41.0) | 15 (40.5) | ||
bilateral | 40 (14.5) | 30 (12.6) | 10 (27.0) | ||
Lobe | frontal | 59 (21.4) | 54 (22.6) | 4 (10.8) | 0.229 |
parietal | 46 (16.7) | 40 (16.7) | 6 (16.2) | ||
temporal | 76 (27.5) | 64 (26.8) | 12 (32.4) | ||
occipital | 14 (5.1) | 14 (5.9) | 0 | ||
multilocular | 76 (27.5) | 62 (25.9) | 14 (37.8) | ||
other | 5 (1.8) | 5 (2.1) | 0 | ||
KPS | 80, 20–100 | 80, 20–100 | 80, 40–100 | 0.782 | |
MRC-NPS | pre-operative | 2, 1–5 | 2, 1–5 | 2, 1–5 | 0.186 |
post-operative | 3, 1–5 | 3, 1–5 | 3, 1–5 | 0.443 | |
Difference in MRC-NPS † | <0 | 27 (9.8) | 25 (10.5) | 2 (5.4) | 0.009 * |
=0 | 172 (62.3) | 155 (64.9) | 17 (45.9) | ||
>0 | 77 (27.9) | 59 (24.7) | 18 (48.6) | ||
Main onset symptom | seizure | 43 (15.6) | 37 (15.5) | 6 (16.2) | 0.148 |
motor deficit | 78 (28.3) | 74 (31.0) | 4 (10.8) | ||
aphasia/dysphasia | 44 (15.9) | 35 (14.6) | 9 (24.3) | ||
visual deficit | 11 (4.0) | 9 (3.8) | 2 (5.4) | ||
cognitive deficit | 21 (7.6) | 19 (7.9) | 2 (5.4) | ||
change in character | 22 (8.0) | 19 (7.9) | 3 (8.1) | ||
headache | 30 (10.7) | 22 (9.2) | 8 (21.6) | ||
reduced vigilance | 6 (2.2) | 6 (2.5) | 0 | ||
none | 5 (1.8) | 4 (1.7) | 1 (2.7) | ||
other | 16 (5.8) | 14 (5.9) | 2 (5.4) | ||
EOR, % | 72.2, 0–100 | 74.5, 0–100 | 36.7, 0–100 | 0.111 | |
Post-operative complication | without | 182 (65.9) | 164 (68.6) | 18 (48.6) | 0.012 * |
with | 94 (34.1) | 75 (31.4) | 19 (51.4) | ||
LOS, days | 14, 4–72 | 14, 4–72 | 14, 6–37 | 0.705 | |
LOS on ICU, days | 1, 1–43 | 1, 1–43 | 1, 1–29 | 0.109 | |
MGMT status | negative | 123 (44.6) | 108 (45.2) | 15 (40.5) | 0.580 |
positive | 153 (55.4) | 131 (54.8) | 22 (59.5) | ||
Adjuvant therapy | without | 63 (22.8) | 54 (22.6) | 9 (24.3) | 0.36 |
radiotherapy | 48 (17.4) | 39 (16.3) | 9 (24.3) | ||
radio-chemotherapy | 165 (59.8) | 146 (61.1) | 19 (51.4) | ||
Discharge disposition | home | 202 (73.2) | 176 (73.6) | 26 (70.2) | 0.776 |
radio-oncology | 32 (11.6) | 27 (11.3) | 4 (10.8) | ||
rehabilitation clinic | 17 (6.2) | 12 (5.0) | 5 (13.5) | ||
palliative care/hospice | 25 (9.1) | 24 (10.0) | 2 (5.4) |
Multivariate Cox Regression | ||||||
---|---|---|---|---|---|---|
HR | 95 CI | p Value | HR | 95 CI | p Value | |
UER | 2.755 | 1.852–4.098 | <0.001 * | 3.875 | 2.473–6.072 | <0.001 * |
Age | 1.028 | 1.012–1.044 | <0.001 * | 1.013 | 0.995–1.031 | 0.156 |
Hemisphere | 1.331 | 1.06–1.673 | 0.014 * | 1.244 | 0.968–1.599 | 0.089 |
Location | 1.282 | 1.151–1.427 | <0.001 * | 1.103 | 0.974–1.249 | 0.122 |
KPS | 0.982 | 0.974–0.989 | <0.001 * | 0.997 | 0.981–1.013 | 0.707 |
MRC-NPS, pre-operative | 1.459 | 1.238–1.719 | <0.001 * | 0.887 | 0.557–1.414 | 0.615 |
MRC-NPS, post-operative | 1.621 | 1.368–1.921 | <0.001 * | 1.473 | 0.991–2.189 | 0.056 |
MRC-NPS, difference † | 1.178 | 0.908–1.527 | 0.217 | 0.556 | 0.316–0.978 | 0.042 * |
Main onset symptom | 1.086 | 1.030–1.145 | 0.002 * | 1.045 | 0.98–1.114 | 0.181 |
EOR | 0.992 | 0.989–0.995 | <0.001 * | 0.995 | 0.992–0.999 | 0.025 * |
Post-operative complication | 1.380 | 0.999–1.906 | 0.051 | 0.987 | 0.64–1.523 | 0.953 |
LOS | 1.033 | 1.015–1.052 | <0.001 * | 0.975 | 0.946–1.004 | 0.094 |
LOS on ICU | 1.076 | 1.048–1.104 | <0.001 * | 1.01 | 0.971–1.05 | 0.63 |
MGMT status | 0.591 | 0.432–0.809 | 0.001 * | 0.594 | 0.426–0.829 | 0.002 * |
Adjuvant therapy | 0.281 | 0.225–0.351 | <0.001 * | 0.353 | 0.266–0.468 | <0.001 * |
Discharge disposition | 2.098 | 1.776–2.479 | <0.001 * | 1.671 | 1.359–2.054 | <0.001 * |
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Kasper, J.; Wach, J.; Vychopen, M.; Arlt, F.; Güresir, E.; Wende, T.; Wilhelmy, F. Unplanned 30-Day Readmission in Glioblastoma Patients: Implications for the Extent of Resection and Adjuvant Therapy. Cancers 2023, 15, 3907. https://doi.org/10.3390/cancers15153907
Kasper J, Wach J, Vychopen M, Arlt F, Güresir E, Wende T, Wilhelmy F. Unplanned 30-Day Readmission in Glioblastoma Patients: Implications for the Extent of Resection and Adjuvant Therapy. Cancers. 2023; 15(15):3907. https://doi.org/10.3390/cancers15153907
Chicago/Turabian StyleKasper, Johannes, Johannes Wach, Martin Vychopen, Felix Arlt, Erdem Güresir, Tim Wende, and Florian Wilhelmy. 2023. "Unplanned 30-Day Readmission in Glioblastoma Patients: Implications for the Extent of Resection and Adjuvant Therapy" Cancers 15, no. 15: 3907. https://doi.org/10.3390/cancers15153907